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Investigations of lymphoma

Investigations of lymphoma. FBE / CBC U&E LFT ESR LDH Beta 2 microglobulin Protein electrophoresis HIV and HTLV II serology. General blood tests. Look for:anaemia ,  WCC, lymphopenia , neutrophilia / neutropenia , eosinophilia. FBE.

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Investigations of lymphoma

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  1. Investigations of lymphoma

  2. FBE / CBC U&E LFT ESR LDH Beta 2 microglobulin Protein electrophoresis HIV and HTLV II serology General blood tests

  3. Look for:anaemia, WCC, lymphopenia, neutrophilia/ neutropenia, eosinophilia FBE

  4. Check serum creatitine and renal function: ureteric obstruction secondary to lymph node enlargement can cause renal impairment • Check calcium, phosphate, and sodium • Check renal function prior to treatment U&E

  5. LFT

  6. Elevated in Hodgkin's disease and NHL • fairly non-specific and should not be used for screening ESR LDH • Bad prognosis if it is increase in Hodgkin’s disease and NHL

  7. may be elevated and correlates with a poor prognosis in NHL Beta 2 microglobulin

  8. Protein electrophoresis

  9. HIV serology is done because antiviral therapies can improve disease outcomes in HIV-positive patients in NHL and HD. • In NHL, HIV serology is done for patients with diffuse large cell immunoblastic or small noncleavedhistologies. • HTLV II serology is done for adult T-cell lymphoma-leukemia HIV and HTLV II serology

  10. Structural imaging (Conventional method of staging) • CT (neck to pelvis) • MRI • CXR • Functional imaging • PET scan • Gallium scan • Bone scan Imaging

  11. It is the most widely used test for initial staging, assessing treatment response, and conducting follow-up care • Possible abnormal findings include enlarged lymph nodes, hepatomegaly and/or splenomegaly, lung nodules or infiltrates, and pleural effusions. • Mediastinallymphadenopathy, is a very common finding in classic Hodgkin disease, although it is uncommon in NodularLymphocyte-PredominantHodgkin'sDisease CT (neck to pelvis)

  12. Ct's showed lypmhadenopathy in the left inguinal node and the left iliac fossa

  13. MRI is done when there is a suspicion of CNS involvement egprimary CNS lymphoma, or vertebral body involvement by lymphoma MRI

  14. CXR is more indicated for NHL eg for identification of hilar or mediastinaladenopathy, pleural or pericardial effusions, and parenchymal involvement CXR

  15. considered to be essential to the initial staging of Hodgkin disease • can be used for the initial evaluation of patients with NHL • more useful for post-treatment evaluation to differentiate early recurrences or residual disease from fibrosis or necrosis. PET scan

  16. Appears to be sensitive for detecting NHL in extranodal sites • Reliability to detect bone marrow involvement is questioned • Better than gallium and equal to CT to detect disease sites in intermediate to high grade NHL and Hodgkin’s • PET scan has a higher predictive value for relapse than classic CT scan imaging • Scarce availability so x always practical PET scan

  17. the use is nearly all replaced by PET scan Gallium scan (nuclear medicine)

  18. Increased uptake of gallium in inguinal lesion before treatment

  19. It is done if suspected BM involvement eg bone pain or elevated ALP • In NHL, one lesions are particularly associated with the acute form of adult T-cell lymphoma-leukemia and diffuse large B-cell lymphomas Bone scan

  20. Light microscopy and H&E are the mainstay of pathologic diagnosis • Flow cytometry: marked increased in monoclonal cells indicate lymphoma • Immunoperoxidase: special staining using specific marker antibody to determine the type of lymphoma Histology

  21. Specific CD marker

  22. Lymph node sample • Fine needle aspiration • Needle-core biopsy / incisional biopsy • Excision biopsy • Bone marrow sample • Trephine / biopsy • Aspirate • Biopsy of extranodal sites • Lumbar puncture • Staging laparotomy • Pleural effusion sampling Histology

  23. Lymph node sample

  24. Histopathologic image of Hodgkin's lymphoma. CD30 (Ki-1) immunostain.

  25. Histopathologic image of Hodgkin's lymphoma. Lymph node biopsy. H & E stain.

  26. Malignant B-cell lymphocytes seen in Burkitt's lymphoma, stained with hematoxylin and eosin (H&E) stain

  27. Histopathology of diffuse large B-cell lymphoma occurring in the tonsil. H&E stain.

  28. Histopathology of diffuse large B-cell lymphoma occurring in the tonsil. CD20 (L26) immunostain.

  29. lymphoma in the bone marrow is often patchy, so bilateral bone marrow biopsies is indicated • HD: • Bone marrow involvement is more common in elderly individuals, in patients with advanced-stage disease, in the presence of systemic symptoms, and in patients with a high-risk histology. • A bone marrow biopsy can be omitted in patients with stage I Hodgkin disease (Hodgkin's lymphoma) and some patients with stage II disease without hematologic abnormalities.  • For NHL, bone marrow sampling is done for staging rather than diagnosis Bone marrow sample (trephine/aspirate)

  30. Sensitive for the presence of lymphoma at light microscopy level when there are sufficient cells to be identified by the pattern they form or number of cells present • Sensitivity can be increased by using CD marker to identify subgroup of lymphocytes, but because lymphocytes are normally present in BM, the pattern and number are important. • PCR to detect presence of translocation or oncogenes can increase the sensitivity and give better measure of prognosis Bone marrow trephine

  31. In some patients with NHL, the extranodal sites are the primary presenting sites, and the most common site is the GI tract. Biopsy of extranodal sites

  32. CNS involvement with Hodgkin disease (Hodgkin's lymphoma) is exceedingly rare • In patient with NHL, it should be performed if • Diffuse aggressive NHL with bone marrow, epidural, testicular, paranasal sinus, nasopharyngeal involvement, or patient with two or more extranodal sites of disease. • High-grade lymphoblastic lymphoma • High-grade small noncleaved cell lymphomas (eg, Burkitt and non-Burkitt types) • HIV-related lymphoma • Primary CNS lymphoma • Patients with neurologic signs and symptoms Lumbar puncture (if symptoms or signs of CNS involvement are present)

  33. involves splenectomy with biopsies of the liver and lymph nodes in the para-aortic, mesenteric, portal, and splenichilar regions. Rarely done Staging laparotomy

  34. Sampling of a pleural effusion by thoracentesis and examination of the cells obtained may be useful in the evaluation of Hodgkin disease (Hodgkin's lymphoma). Pleural effusion sampling

  35. Staging: Ann Arbor classification

  36. In patients with stage I or II disease, the following factors are considered unfavourableand, if present, will increase the intensity of the recommended initial therapy: • Large mediastinaladenopathy • An ESR result (a general marker of inflammation) 50 mm/h or higher, if the patient is otherwise asymptomatic OR ESR > 30 if hv B symptoms • More than 3 sites of disease involvement • The presence of B symptoms • The presence of extranodal disease • Age above 50 at diagnosis

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